The Acute Care Surgeon in Pandemics: Lessons from COVID-19

Abstract

The pandemic in 2020 has had economic, health, social, and cultural impacts on the entire world's population. At the time of writing the coronavirus disease 2019 (COVID-19), a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had infected over 65 million people causing 1.5 million deaths with ongoing exponential growth in case numbers in many parts of the world. The impact of surgical care delivery has been profound. Initial orders to cancel elective surgery preserved inadequate stockpiles of personal protective equipment and prevented exposures of surgical patients to asymptomatic COVID-19 infected persons in the face of insufficient testing. However, this led to a backlog of elective surgery. There were also delays in presentation of acute surgical conditions, probably due to patient fears of contracting COVID-19 at hospitals. Surgeons were required to develop processes such as creation of dedicated COVID-19 operating rooms to prevent nosocomial spread of the disease and infection of the operating room team. Surgeons have provided surgical and critical care to COVID-19 patients during the current pandemic despite initial shortages of ventilators, PPE and information. Surgeons are now successfully managing acute surgical complications of COVID-19 as well as COVID-19 patients presenting with trauma and non-COVID-19 related acute surgical conditions, despite early reports of poor outcomes. Lessons learned included issues in preparation, training, planning, provider wellness, burnout, surgical disparities, testing, PPE, operating rooms, cancellations of elective surgery, regional coordination, and information technology. Surgeons should be now ready to engage in advocacy efforts to ensure that the next pandemic can be better handled by the healthcare system.

Are trauma surgeons prepared? A survey of trauma surgeons’ disaster preparedness before and during the COVID-19 pandemic

“…5 6 The SARS-CoV-2 (COVID-19) pandemic created patient surges that critically stressed US hospitals, including TCs, and negatively impacted patient outcome quality markers and timely access to non-emergent care. [7][8][9][10] The effects of COVID-19 on surgeon and TC emergency preparedness are incompletely characterized but have been explored in the context of the firearm injury epidemic. 11 Therefore, our primary aim was to characterize current trauma surgeon and TC preparedness for disaster management.…”